"Digitizing the health system is an effort to accelerate equity and reduce disparities in health services. However, digitalization needs to be accompanied by a reliable internet connection, digital literacy, and personal data security."

After proposing the idea of BPJS for affluent individuals at the end of last year, The Health Minister of Indonesia, Budi Gunadi Sadikin, has recently made a surprising move. Since March 1, 2023, the popular PeduliLindungi application used during the Covid-19 pandemic is now integrated into the Satu Sehat platform as of March 1, 2023. This integration was previously prepared by the Ministry of Health.

The integration of these two applications is intended to enhance Indonesia's health resilience among millennials. The Satu Sehat platform links different applications relevant to healthcare, including government and private hospitals, health centers, posyandu, laboratories, clinics, and pharmacies. This ensures that data becomes integrated across different sectors.

For instance, patients no longer have to carry their medical records from the health center to the referral hospital because all the data can be accessed through the Satu Sehat platform. With the integration of the PeduliLindungi application into the Satu Sehat platform, all Covid-19 vaccination data is automatically linked to all healthcare facilities and stakeholders.

The Satu Sehat platform allows access to various data related to vaccinations, including information originating from the PeduliLindungi application, such as vaccination history, location of vaccination, and vaccination certificates.

The Covid-19 pandemic, which has been going on for three years, has not only brought unwanted events, but also brought blessings in the form of meaningful life lessons, which have spawned many innovations, especially those related to handling the pandemic.

Some of these innovations are the manufacture of local ventilators, the G-nose detection system, the establishment of a molecular biology team that has succeeded in sequencing the viral genome, there are also teams that have succeeded in developing a national vaccine, such as Inavac (Universitas Airlangga - PT. Biotis Pharmaceutical) or Indovac (PT Bio Farma - Baylor College of Medicine).

To manage transmission control, the PeduliLindungi application was developed to collect vaccine recipient data and integrate it with GPS to monitor residents' movements.

This application is used by almost all modes of transportation, hotels, offices, malls, restaurants, meeting halls, and various other places to screen and permit citizens who have been vaccinated. As a result, the risk of spreading the virus is more effectively managed. These are some of the positive outcomes that have emerged from the efforts to combat the pandemic.

The integration of the Peduli Lindungi application into the Satu Sehat platform demonstrates the Ministry of Health's continued efforts to develop the health system based on digital technology. 

This integration marks the realization of the sixth pillar of Health System Transformation that was introduced on July 22, 2022, which aims to transform primary and referral services, health resilience system, health financing, health human resources, and health technology.

The Satu Sehat platform represents a significant step towards restructuring the health system, as it integrates all medical data collection and reporting. 

Currently, there are at least 400 government-owned health applications that have not been integrated. Each application collects data about the same health reporting, resulting in overlapping, unfocused and inefficient data. Now, the Satu Sehat platform has reduced it to just eight applications so that they are more concise and integrated. Health workers do not need to repeatedly enter the same data in different applications.

Patient medical record history data can be put together in one platform, not scattered, making it easier for health services to use it, be it the health centers, hospitals, pharmacies, even ministries, educational institutions, research institutes, or other agencies that are allowed access.

Research institutions can also benefit. For example, from the collected demographic data and the health profile of the Indonesian population, it is possible to map patterns of diabetes, obesity and their association with heart disease and stroke. The pattern of consumption of drugs and health supplements can also be mapped so that the national capitalization figures can be identified and accessed by the public. This can be a reference for formulating various policies and regulations regarding health services.

In addition, so far there have been many private health applications that have not been connected to the health service ecosystem built by the government. The non-uniformity of data between applications, which originates from the non-uniformity of data between agencies, will create difficulties for the standardization and integration of health services.

The Satu Sehat platform eliminates data discrepancies and ensures that data is standardized and integrated across all health services.

AI for healthcare systems

It can be said, the progress of digital technology has jumped far relatively faster than technology in other sectors. Digital technology has progressed rapidly, particularly in the fields of virtual reality, augmented reality, blockchains, and artificial intelligence (AI).

The integration of the Peduli Lindungi application into the Satu Sehat platform coincides with the emergence of ChatGPT, an AI-powered chatbot developed by OpenAI in December 2022. This is a chatbot released by OpenAI, which relies on the power of artificial intelligence (AI) to answer all questions. AI is expected to lead the development of many technologies, including health systems.

The use of AI will significantly support the development of the Satu Sehat platform, particularly in clinical applications, such as helping to formulate diagnoses, creating surgical simulations, developing post-surgery recovery plans, and compiling clinical risk analyses. The effectiveness of AI's capabilities will depend on the completeness of input data, the algorithm used, and the computational power available.

In the medical ecosystem, AI can help estimate disease threats, develop risk assessments, and suggest appropriate mitigation measures. For basic medical research based on molecular analysis, AI can assist in diagnosing various diseases, including rare genetic diseases. For example, by combining genomic sequencing models to analyze the patient's entire genome, AI can detect mutations that cause diseases such as Down syndrome and other rare diseases.

Currently, AI can detect more than 4,000 rare genetic disorders. Therefore, the development of the Satu Sehat platform with AI technology is a necessary step towards creating a comprehensive health system.

Infrastructure, data literacy and security

In order to promote equity and reduce disparities in health services, it is crucial to digitize the health system. However, there are three pressing short-term issues that must be addressed immediately for the Satu Sehat platform to effectively reach all citizens: improving internet network connections, enhancing citizens' digital literacy, and ensuring the security of their personal data.

Currently, there are still many areas without internet access, while other areas have unstable networks. The development of base transceiver stations (BTS) must be evenly distributed to all regions, including disadvantaged and remote areas. 

Additionally, digital literacy among citizens is still low, which hinders their ability to keep up with the rapid advances in digital technology. Low levels of understanding and skills in using digital technology and in security pose challenges.

Increasing digital literacy will greatly support the use of digital health systems. The integrated health platform will help with precise and fast decision-making processes based on accurate data. This applies to both medical and clinical decisions in hospitals, epidemiology, and policy decisions in other agencies, such as the Ministry of Health.

While advances in digital technology hold great promise, they also require high vigilance. The most significant risk in the process of digitizing the health system is data security. There are frequent cases of large-scale personal data theft, which is then sold to other parties for commercial use.

Data protection is still weak, and if the Satu Sehat server is successfully compromised by hackers, citizens' health profile data could be valuable to private parties outside the government. This includes information such as names, emails, addresses, genders, dates of birth, medical history, hospital visits, doctor visits, medication purchases, and pharmacies.

Therefore, in tandem with the development of the Satu Sehat platform, it is necessary to prepare data security measures and strengthen regulations to take firm action against perpetrators of personal data theft. Hopefully, the Satu Sehat platform can improve health services and contribute to strong national health resilience.

Djoko Santoso
Professor at Faculty of Medicine, Universitas Airlangga
Chairman of Health Department, Indonesian Council of Ulama, East Java

Translated from:
Digitalisasi Transformasi Sistem Kesehatan
by Djoko Santoso
Kompas, 4 April 2023
Source: https://www.kompas.id/baca/opini/2023/04/03/digitalisasi-transformasi-sistem-kesehatan